Pending Veterans Health Legislation

Chairman Isakson, Ranking Member Tester, and distinguished members of the committee; On behalf of National Commander Brett P. Reistad, and the 2 million members of The American Legion, we thank you for this opportunity to testify regarding The American Legion’s positions on pending legislation. Established in 1919, and being the largest veterans service organization in the United States with a myriad of programs supporting veterans, we appreciate the committee focusing on these critical issues that will affect veterans and their families. 

S. 123

To require the Secretary of Veterans Affairs to enter into a contract or other agreement with a third party to review appointees in the Veterans Health Administration who had a license terminated for cause by a State licensing board for care or services rendered at a non-Veterans Health Administration facility and to provide individuals treated by such an appointee with notice if it is determined that an episode of care or services to which they received was below the standard of care, and for other purposes.

The American Legion has taken no previous position on this matter. As a large, grassroots organization, The American Legion takes positions on legislation based on resolutions passed by our membership. With no resolutions addressing the provisions of the legislation, The American Legion is researching the material and working with our membership to determine the course of action that best serves veterans.

The provisions in this bill fall outside the scope of established resolutions of The American Legion. The American Legion does not have a resolution that addresses the authorization of appropriations in the VA for awarding grants to VSOs for transportation in highly rural areas. 

The American Legion does not have a resolution to support or oppose S. 123.

S.221

To amend title 38, United States Code, to require the Under Secretary of Health to report major adverse personnel actions involving certain health care employees to the National Practitioner Data Bank and to applicable State licensing boards, and for other purposes.

S. 221 would require the VA to report major adverse actions to the National Practitioner Data Bank (NPDB) and state licensing boards within 30 days after the date a major adverse action is taken against a VA employee. The NPDB is a United States Government program that collects and discloses, only to authorized users, negative information on health care practitioners, including malpractice awards, loss of license, or exclusion from participation in Medicare or Medicaid. It would also prohibit VA from signing settlements with terminated VA employees and would forbid VA from concealing serious medical errors or to purge negative records from employees’ personnel files. 

The VA lists integrity as its first core value, and VA employees make the promise to act with high moral principle and adhere to the highest professional standards. The vast majority of VA healthcare providers are well-trained, caring, public servants who work hard to take care of this nation’s veterans. Just like in any healthcare system, though, there are bad apples. This legislation would help ensure that incidences of malpractice do not go unreported by imposing new oversight measures on the VA, thus safeguarding the safety and wellbeing of those who are cared for by the VA healthcare system.

Through Resolution No. 377, The American Legion urges Congress and the VA to enact legislation and programs within the VA that will enhance, promote, restore or preserve benefits for veterans and their dependents, including, but not limited to, the following: timely access to quality VA health care; timely decisions on claims and receipt of earned benefits; and final resting places in national shrines and with lasting tributes that commemorates their service.

The American Legion supports bill S. 221.

S. 318

To amend Section 1786 of title 38, United States Code, to authorize the Secretary of Veterans Affairs to furnish medically necessary transportation for newborn children of certain women veterans, and for other purposes.

Title 38 U.S.C. 1786 currently authorizes the Secretary of Veterans Affairs to furnish post-delivery care services, including routine care services, that a newborn child of a woman veteran who is receiving maternity care furnished by the Department at a facility of the Department; or  another facility pursuant to a Department contract for services relating to such delivery.

Since VA healthcare facilities do not offer a full-range of newborn care, women veterans are referred to community hospitals for post newborn and routine services at VA expense. The only exception is VA is not authorized to pay for medically necessary transportation for newborn children of certain veterans. This bill would provide the VA Secretary the authority to furnish medically necessary transportation for newborn children, which The American Legion supports and believes is the right thing to do.

Through Resolution No. 147, The American Legion works to ensure that the needs of the current and future women veteran populations are met; and that the VA provides full comprehensive health services for women veterans Department-wide, including, but not limited to, increasing treatment areas and diagnostic capabilities for female veteran health issues, improved coordination of maternity care, and increase the availability of female therapists/female group therapy to better enable treatment of Post-Traumatic Stress Disorder from combat and MST in women veterans.

The American Legion supports S. 318.

S. 450

To require the Secretary of Veterans Affairs to carry out a pilot program to expedite the onboarding process for new medical providers of the Department of Veterans Affairs, to reduce the duration of the hiring process for such medical providers, and for other purposes.

The American Legion has testified on similar issues concerning identifying and attracting quality candidates to provide health care for the nation’s veterans.

The American Legion is deeply troubled by the Department of Veterans Affairs (VA) leadership, physicians and medical specialist staffing shortages within the Veterans Health Administration (VHA). Since the inception of our System Worth Saving program in 2003, The American Legion has identified, and reported staffing shortages at every VA medical facility and reported these critical deficiencies to Congress, the VA Central Office (VACO), and the President of the United States.

In 2018, VA reported there were more than 33,000 full-time vacancies.[1] Many of these vacancies included hard-to-fill clinical positions, as well as occupations identified under 38 U.S.C. 7412. These findings were reinforced by a VA’s Office of Inspector General (VAOIG) report determining the largest critical need occupations are medical officers, nurses, psychologists, physician assistants, and medical technologists. [2] The VA needs to identify and attract as many qualified candidates as possible as soon as possible.

Through American Legion Resolutions No. 115,  Department of Veterans Affairs Recruitment and Retention, [3]  and No. 377, Support for Veteran Quality of Life, we support legislation addressing recruitment and retention challenges, and any legislation or programs within VA that enhance, promote, restore or preserve benefits for veterans and their dependents, including, but not limited to, the following: timely access to quality VA health care, timely decisions on claims and receipt of earned benefits, and final resting places in national shrines with lasting tributes that commemorate their service. [4] 

The American Legion supports S. 450.

S. 514

To amend title 38, United States Code, to improve the benefits and services provided by the Department of Veterans Affairs to women veterans, and for other purposes.

Women veterans have consistently been overlooked by the Department of Veterans Affairs for decades. The American Legion feels that it is time that we thank this growing military demographic with, at a minimum, the healthcare they deserve. Women veterans are the fastest growing demographic serving in the military, so we can expect the number of women veterans using Department of Veterans Affairs (VA) healthcare to increase dramatically. The United States has more than 2 million women veterans who live in every Congressional district in the nation, and the number of women veterans seeking VA health care has doubled since 2000.

Although the VA has made improvements in women’s healthcare, many challenges remain. The Deborah Sampson Act would help rectify many issues women veterans face by improving the ability of the VA to provide women’s care, improve services, and change its culture to embrace this growing population. It does so by, inter alia:

• Enhancing services that empower women veterans to support each other,
• Establishing a partnership between the Department of Veterans Affairs and at least one community entity to provide legal services to women veterans,
• Make adjustments to care that the VA can provide newborns,
• Addressing significant barriers women veterans face when seeking care,
• Require the VA to collect and analyze data for every program that serves veterans, including the Transition Assistance Program, by gender and minority status, and require that they publish data as long as it does not undermine the anonymity of a veteran.

The American Legion recommends the following change to the bill. A separate track to address specific needs of women veterans attending the Transition Assistance Program. It has been noted that women veterans are more likely to seek assistance by talking with other women on gender-sensitive assistance. For example, the VA Trauma Service Program (TSP)  allows women veterans to choose to partake in a TSP information session with a group or with an individual woman coordinator. More women veterans opt to conduct the information session with an individual woman coordinator.  Additionally, The American Legion requests the Department of Defense transfer contact information of all transitioning women veterans to the VA and the Department of Labor (DoL). This would provide an opportunity for the VA, DoL, and Veterans Service Organizations to follow-up with women veterans after separation to offer additional support, programs, and services. American Legion Resolution No. 147, Women Veterans, calls on The American Legion to work with Congress and the VA to ensure that the needs of current and future women veteran populations are met. It calls on the VA to provide full comprehensive health services for women veterans department-wide.

American Legion Resolution No. 364, Department of Veterans Affairs to Develop Outreach and Peer to Peer Program for Rehabilitation supports the President of the United States and the U.S. Congress passing legislation to call on the Secretary of Veterans Affairs to develop a national program to provide peer to peer rehabilitation services based on the recovery model tailored to meet the specialized needs of current generation combat-affected veterans and their families.

The American Legion supports passage of S. 514.

S. 524

To establish the Department of Veterans Affairs Advisory Committee on Tribal and Indian Affairs, and for other purposes.

The American Legion has not passed a resolution specific to the topic at hand. However, through our congressional engagement on behalf of Veterans, VA Mobile Vet Centers will be used to visit Native American reservations to provide counseling and other psychological services to Veterans. Additionally, American Legion Posts 143 and 165 have supported the National Native American Veterans Memorial project’s community consultations, events, and programs.  [5] We believe that the Native communities at one of the most underserved population of Veterans and that they are not receiving the benefits and critical care they, like their veteran counterparts, are entitled to. The American Legion supports legislation aimed at directly enhancing veterans’ quality of life by expanding their VHA, VBA, or NCA benefits.  [6] 

The American Legion supports S. 524.

S. 711

To amend title 38, United Sates Code, to expand eligibility for mental health services from the Department of Veterans Affairs to include members of the reserve components of the Armed Forces, and for other purposes.

Suicide prevention and mental healthcare remain a top priority of The American Legion.  As a response to the high rate of veteran suicide The American Legion established the TBI/PTSD Committee to study and recommend best practices.  Access to mental health has been identified as a barrier, according to the Department of Veterans Affairs (VA) 14 out of the 20 veterans who commit suicide were not receiving treatment from a VA medical facility.  A veteran may not be eligible for VA benefits including mental health treatment due to their characterization of discharge or duty status.  As a response to close the gap in access The American Legion passed resolution No. 23 to allow veterans with other than honorable discharges to receive mental health treatment at the VA.  In an effort to reduce the number of veterans and Service members who commit suicide The American Legion believes that service through the VA should be a viable option.

The American Legion supports S. 711

S. 746

To require the Secretary of Veterans Affairs to conduct a study on the accessibility of websites of the Department of Veterans Affairs to individuals with disabilities, and for other purposes.

The American Legion has not passed a resolution specific to  website accessibility. We recognize the barriers that veterans with certain disabilities face when trying to navigate and utilize certain VA websites and believe that it is essential that we work to remove these barriers. Every veteran should have equal access to and the ability to navigate VA websites.

We believe that no veteran should be inhibited in their efforts to participate in or benefit from VA programs. The VA should bring into compliance, websites that are not currently accessible to individuals with certain disabilities. Veterans should not encounter unavoidable barriers to benefits and critical care they, like their veteran counterparts, are entitled to. The American Legion supports legislation aimed at directly enhancing veterans’ quality of life by expanding their VHA, VBA, or NCA benefits. [7] 

The American Legion supports S. 746.

S. 785

To improve mental health care provided by the Department of Veterans Affairs, and for other purposes.

It is estimated that more than twenty veterans die by suicide every day. Of those twenty, fourteen have received no treatment or care from the VA. Suicide among veterans continues to be higher than the rest of the population, with an even sharper increase among younger veterans. VA data released in September showed the rate of suicide among veterans ages 18 to 34 had significantly increased. Forty-five of every 100,000 veterans in the 18 to 34 age group committed suicide in 2016.

In 2018, VA reported there were more than 33,000 full-time vacancies. Many of these vacancies included hard-to-fill clinical positions, as well as occupations identified under 38 U.S.C. 7412. These findings were reinforced by a VA’s Office of Inspector General (VAOIG) report determining the largest critical need occupations are medical officers, nurses, psychologists, physician assistants, and medical technologists.  The VA needs to identify and attract as many qualified candidates as possible as soon as possible.

The Commander John Scott Hannon Veterans Mental Health Care Improvement Act will improve outreach to veterans and their mental health care options. Among its many provisions regarding suicide prevention and access to treatment, the legislation directs the VA to work with the Office of Personnel Management to create an occupational series for mental health counselors.

The bill also would mandate that the Secretary of Veterans Affairs submit a staffing plan that would increase the hiring of mental health counselors to the Senate and House Veterans’ Affairs Committees within 270 days of passage. The VA would also be required to report on the specific number of mental health counselors it has hired based on the staffing plan.

The provisions of this bill address many areas of concern The American Legion has raised recently. The American Legion remains deeply troubled by the Department of Veterans Affairs (VA) leadership, physicians, and medical specialist staffing shortages within the Veterans Health Administration (VHA).  Additionally, mental healthcare is a major concern for The American Legion, we have seen the hardships faced by our veterans and their dependents dealing with PTSD, TBI, Suicide Ideation, and many other mental health issues. The American Legion has created a TBI/PTSD Committee and has a dedicated staff member for the sole purpose of advocating on behave of veterans dealing with the before mentioned mental health issues.

Further, last month, National Commander Brett Reistad with Dr. Keita Franklin, VA’s Executive Director of Suicide Prevention, penned a letter to nearly 850,000 American Legion members, family, and friends, to let them know we are working to adopt a public health approach to suicide prevention.

The public health approach looks beyond the individual to involve peers, family members and the community in preventing suicide. We understand preventing veteran suicide is a top priority for VA and we encourage  VA to look to dedicated partners to reach veterans outside the VA health-care system. The letter provided links to VA’s National Strategy for Preventing Veteran Suicide, a toolkit that includes a guide to online suicide prevention resources, and a resource locator for contacting local VA Suicide Prevention Coordinators.

The American Legion supports S. 785.

S. 805

To amend title 38, United Sates Code, to improve the processing of veterans benefits by the Department of Veterans Affairs, to limit the authority of the Secretary of Veterans Affairs to recover overpayments made by the Department and other amounts owed by veterans to the United States, to improve the due process accorded veterans with respect to such recovery, and for other purposes.

The VA is responsible for distributing monthly earned benefits to veterans and their beneficiaries. Currently, when the VA makes an overpayment in error to a veteran, the VA can then withhold some or all of a veteran’s benefit, without limitation, including

monthly disability benefit payments. For veterans who live on a fixed income, withholding a benefit payment due to no fault of their own can present an undue hardship in their ability to pay rent or buy groceries.

The VA annually sends as many as 200,000 overpayment notices totaling thousands of dollars to veterans and their families, sending them into crippling debt and withholding future benefits payments until the debt is paid. These overpayments are often a result of the VA’s own accounting errors, but the VA puts veterans and their families on the hook for repaying the debt.

Debt caused by VA overpayments are a major concern for The American Legion, we have seen the financial hardship veterans and their dependents end up and in many cases through no fault of their own.  Since 1978 The American Legion has retained a dedicated staff member at the Debt Management Center for the sole purpose of advocating on behave of veterans and their dependents facing garnishment.

If enacted, the Veteran Debt Fairness Act, will prevent the VA from collecting debt if caused by errors at the VA. The bill would allow the VA to recoup overpayments only if the debt was due to an error or fraud on the part of the veteran or beneficiary. Additionally, to reduce the risk of financial hardship, the legislation states that the VA cannot deduct more than 25 percent from a veteran’s monthly payment in order to recoup overpayment. It also requires the VA to provide veterans with a way to update dependency information on their own, eliminating a common delay that may affect a veteran’s benefits.

The American Legion has testified and recommended many of the above changes, if passed the legislation would greatly improve the way VA manages debt collection while minimizing the negative impact for veterans.

The American Legion supports S. 805.

S. 850

To extend the authorization of appropriations to the Department of Veterans Affairs for purposes of awarding grants to veterans service organizations for the transportation of highly rural veterans.

The American Legion has taken no previous position on this matter. As a large, grassroots organization, The American Legion takes positions on legislation based on resolutions passed by our membership. With no resolutions addressing the provisions of the legislation, The American Legion is researching the material and working with our membership to determine the course of action that best serves veterans.The provisions in this bill fall outside the scope of established resolutions of The American Legion. The American Legion does not have a resolution that addresses the authorization of appropriations in the VA for awarding grants to VSOs for transportation in highly rural areas. 

The American Legion takes no position on S. 850.

S. 857

To amend title 38, United Sates Code, to increase the amount of special pension for Medal of Honor recipients, and for other purposes.

The American Legion has testified before the Subcommittee on Veterans’ Affairs in support of improved benefits for Medal of Honor Recipients. We have also passed resolutions supporting expanded benefits for Medal of Honor Recipients. The Medal of Honor is the highest military decoration awarded to a member of the United States Armed Forces and the recipients have earned this award by displaying heroism and bravery while risking their lives during service to this great nation. The American Legion fully appreciated the service of those awarded the Medal of Honor and supports legislation that would expand the benefits to Medal of Honor recipients. [8] 

The American Legion supports S. 857.

S. 980

To amend title 38, United States Code, to improve the provision of services for homeless veterans, and for other purposes.

Generally, the causes of homelessness can be grouped into three categories: economic hardships, health issues, and lack of affordable housing. Although these issues affect all homeless individuals, veterans face additional challenges in overcoming these obstacles, including: prolonged separation from traditional supports such as family and close friends; highly stressful training and occupational demands, which can affect personality, self-esteem and the ability to communicate upon discharge; and non-transferability of some military occupational specialties into the civilian workforce. The Departments of Veterans Affairs (VA) and Housing and Urban Development (HUD) reported a little over 40,000 homeless veterans on a single night in January 2017.  We witnessed a slight uptick in homeless veterans last year, due mostly to high cost rental markets. Please note - positive progress has been driven by consistent action at all levels of government and across all sectors. Much progress has been made; however, there is still room for significant improvement with access to resources for at-risk and homeless veterans.

The American Legion supports S.980 because it would allow the VA to enter into partnerships with other entities to expand the legal services available for veterans experiencing homelessness. The legislation would also require housing providers to take steps to better meet needs of women veterans, and would amend VA rules to ensure the children of homeless veterans are allowed to live in VA-run transitional housing programs. S.980 would also authorize the VA to provide dental care to homeless veterans, which has been a top ten need in the VA’s Project CHALENG (Community Homelessness Assessment, Local Education and Networking Groups) survey for many years. Lastly, the bill would increase the authorization limit for the Supportive Services for Veteran Families (SSVF) Program to $500 million, opening the door for the renewal of surge grants set to expire at the end of the year.

The American Legion maintains a sustained focus on the prevention of veteran homelessness (“get them before they get on the street”). We offer support to at-risk and/or homeless veterans and their families in the forms of informal advice and counseling, assistance with obtaining VA healthcare and benefits, temporary financial assistance (TFA), aid from the Child Welfare Foundation (CWF), and assistance with employment through our Career Fairs and Veteran-Owned and Service-Disabled Veteran-Owned Small Business Development Workshops (educational forums). This kind of assistance is available from the Post level up to The American Legion’s national organization.

Lastly, based upon the small rise in veteran homelessness, this is no time to stop funding federal programs or not look to adding necessary resources to assist homeless veterans in obtaining housing, treatment, and financial stability. Consequently, on behalf of the 2 million members of The American Legion, we express support for S.980, the Homeless Veterans Prevention Act of 2017. The American Legion applauds Congress for its substantial funding for homeless programs, while giving major thanks to VA, HUD, and the Department of Labor, for the implementation of their programs that have literally saved the lives of thousands of veterans. We strongly believe that with the path VA has begun in eliminating veteran homelessness and the proper utilization of the resources at the state level and in local communities, we can continue to make tremendous progress.

Resolution No. 324, Funding for Homeless Veterans, supports any legislative or administrative proposal that will provide medical, rehabilitative, and employment assistance to homeless veterans and their families.

The American Legion supports S. 980.

S. 1101

Ensuring only licensed health care providers furnish medical disability examinations under certain Department of Veterans Affairs pilot program for use contract physicians for disability examinations.

The provisions of this bill fall outside the scope of established resolutions of The American Legion.  As a large, grassroots organization, The American Legion takes positions on legislation based on resolutions passed by the membership or in meetings of the National Executive Committee. 

With no resolutions addressing the provisions of the legislation, The American Legion is researching the material and working with our membership to determine the course of action, which best serves veterans.

S. 1154

To amend title 38, United States Code, to establish an advisory committee on the implementation by the Department of Veterans Affairs of an electronic health record.

The VA is currently undertaking a decade-long transition to bring veterans’ health records into the 21st century by ensuring that veterans can have access to a seamless electronic health record across the VA and Department of Defense health systems. The Department of Veterans Affairs Electronic Health Record Advisory Committee Act, would establish a third party oversight group to monitor the VA's $16 billion EHR rollout. The 11-member EHR Advisory Committee would include medical professionals, IT and interoperability specialists, and veterans receiving care from the VA. This committee would operate as an independent entity.

The American Legion, through resolution, has long endorsed and supported the Department of Veterans Affairs (VA) in creating a Lifetime Electronic Health Records (EHR) system. Additionally, The American Legion has encouraged both DoD and the VA to either use the same EHR system, or, at the very least, systems that were interoperable.

The American Legion recognizes the advantages of a bi-directional interoperable exchange of information between agencies. Collaborating with DoD offers potential cost savings and opportunities for VA. Opportunities include capitalizing on challenges DoD encounters deploying its own Cerner solution, applying lessons learned to anticipate and mitigate issues, and identifying potential efficiencies for faster and successful deployment. The EHR is a high-priority initiative that ensures a seamlessly integrated healthcare record between the Department of Defense and VA, by bringing all patient data into one common system.

The American Legion supports S. 1154.

S. ____ Janey Ensminger Act of 2019

A bill to amend the Public Health Service Act with respect to the Agency for Toxic Substances and Disease Registry’s review and publication of illness and conditions relating to veterans stationed at Camp Lejeune, North Carolina, and their family members, and for other purposes.

This draft bill would allow the Agency for Toxic Substances and Disease to collect information regarding service members, veterans, and family members who suffer from a variety of illnesses due to contaminated drinking water at Camp Lejeune , NC. Additionally, this bill would require the Secretary of Veterans Affairs to allocate two million dollars a year to assist service members, veterans, and their families affected by contaminated water at Camp Lejeune, in applying for health benefits through the VA.

During the early parts of the 1980s, contaminants were found in two wells that provided water at Camp Lejeune. These contaminants included the volatile organic compounds trichloroethylene (TCE), a metal degreaser, perchloroethylene (PCE), dry cleaning agents, and vinyl chloride, as well as benzene, and other compounds. It is estimated that the contaminants were in the water supply from the mid-1950’s until February 1985 when the wells were shut down. Additionally, there is evidence of an association between certain diseases and the contaminants found in the water supply at Camp Lejeune during the period of contamination.

United States Marine Corps (USMC) service members and their families living at the base, between the 1950’s to 1985, bathed in and ingested tap water contaminated with harmful chemicals at concentrations ranging from 240 to 3400 times higher than appropriate safety levels. An undetermined number of former base residents later developed cancer or other ailments, which may be associated with the contaminated drinking water. Victims claim that USMC leaders concealed knowledge of the problem and did not act appropriately in resolving it or notifying former base residents that their health might be at risk.

The American Legion is appalled that military members serving our nation, and their families, were exposed to harmful chemical contaminants at Camp Lejeune. We are equally shocked that the USMC was potentially aware of the issue and did nothing to mitigate the risk associated with the water contamination at this military instillation. This bill would allow individuals affected by water contamination at Camp Lejeune to receive healthcare provided by the VA and claim any benefits due to them. Resolution No. 377: Support for Veteran Quality of Life supports legislation that would allow access to quality VA health care and timely decisions on claims and receipt of earned benefits.9 The American Legion strongly supports this draft bill.

The American Legion supports this draft bill.

S.___A bill to amend title 38

A bill to amend title 38, United States Code, to extend the

authority of the Secretary of Veterans Affairs to continue to pay

educational assistance or subsistence allowances to eligible persons when

educational institutions are temporarily closed, and for other purposes.

Presently, when a school closes traditional, non-veteran students have federal protections that support them. Effected students with federal student loans have the ability to discharge their student loans. Students who received Pell Grants can have their eligibility periods reset for the time spent at a closed institution. The American Legion believes strongly that veterans are entitled to the same protection as their civilian counterparts. Over 6,000 student veterans were attending ITT Tech when they abruptly shut down their campuses[9], and more school closures will inevitably occur, and The American Legion applauded provisions in the Harry W. Colmery Veterans Educational Assistance Act that restored these veterans.

Despite this victory, the Forever GI Blil provisions only restored benefits for schools tha tclosed between 2015 and 2017. Congress must not forget about the student veterans affected by school closures outside of this time period, including most recently Argosy University.

Through resolution No. 21: Education Benefit Forgiveness and Relief for Displaced Student-Veterans  The American Legion supports legislation that restores lost benefits to student-veterans attending schools that abruptly shut down.[10]

The American Legion supports this draft bill.

Conclusion

The American Legion thanks this committee for the opportunity to elucidate the position of the 2 million veteran members of this organization. For additional information regarding this testimony, please contact the Legislative Associate of the Legislative Division, Mr. Ernest J. Robinson, at The American Legion’s Legislative Division at (202) 861-2700 or erobinson@legion.org.